IgG4-related Sclerosing disease: a potential new etiology of cutaneous pseudolymphoma.

IgG4-related sclerosing disease is a syndrome characterized by the involvement of a wide variety of tissues by lymphoplasmacytic infiltrates and sclerosis, elevated serum IgG4 titer, and increased IgG4+ plasma cells in tissues. This report describes 2 cases with skin involvement, a feature not well documented in the literature. The patients had plaques or nodules in the skin of the cheek, temporal or periauricular region. Histologically, there was dermal and subcutaneous involvement by a nodular lymphoid infiltration often interspersed with lymphoid follicles and sclerotic stroma. The infiltrate was rich in plasma cells, small lymphocytes, and sometimes plasmablasts. The IgG4+ cell count was high (342 to 425 per high power field), with an IgG4/IgG proportion from 68% to 100%. As the morphology was compatible with pseudolymphoma, 14 cases of cutaneous pseudolymphoma were retrieved from the archives for IgG4 and IgG immunostaining. Two cases exhibited marked increase in IgG4+ cells, and showed many similarities with cutaneous manifestation of IgG4-related sclerosing disease, but the limited available clinical information precluded a conclusion on their nosologic nature. In summary, IgG4-related sclerosing disease can manifest with skin lesions, and is also one of the potential etiologies of cutaneous pseudolymphomas.

A retrospective study of 2585 patients patch tested with the European standard series in Hong Kong (1995-99).

BACKGROUND: Data on patch test findings in Hong Kong are scarce, with the last survey performed more than 10 years ago. A retrospective analysis of results from all patch tests performed on patients with suspected allergic contact dermatitis from January 1995 to December 1999 in the Social Hygiene Service, which provides a public dermatology service in Hong Kong, was undertaken. We aimed to explore the demographic data associated with positive reactions and the profile of contact sensitizing allergens in Hong Kong. METHODS: A total of 2585 patients were patch tested with the European standard series during the period. Most were Chinese, with a female-to-male ratio of 3 : 2. RESULTS: One or more positive responses were noted in 1415 patients (54.7%). The most common allergen was nickel sulfate (24.4%), followed by fragrance mix (13.7%), cobalt chloride (8.7%), p-phenylenediamine (6.0%), and balsam of Peru (5.7%). Nickel sensitivity was more common in female patients, and dichromate sensitivity was more common in male patients (P < 0.001). Female gender, an age of 40 years or below, truncal and upper limb involvement, absence of lower limb involvement, and a positive atopy history were significant risk factors for nickel sensitivity. CONCLUSIONS: This study provides a profile of allergens responsible for allergic contact dermatitis in the public dermatology service in Hong Kong. A prospective study, using a larger panel of allergens, involving patients from both the private and public sectors, would provide a more comprehensive profile of contact allergens in Hong Kong and contribute to the establishment of a local standard series.

Cutaneous and pulmonary sarcoidosis in a Hong Kong Chinese woman with silicone breast prostheses.

Sarcoidosis is rarely reported in Hong Kong. We report cutaneous and pulmonary sarcoidosis in a 54-year-old Chinese woman, who presented with papular lesions over the face and neck. She had silicone breast augmentation surgery 4 years earlier. Skin biopsy revealed granulomatous inflammation and anti-tuberculosis treatment was started empirically but stopped 2 months later owing to a poor response. A right supraclavicular lymph node was aspirated and revealed granulomatous inflammation. The CXR was normal initially but subsequently showed diffuse reticulonodular opacities and a small right-sided pleural effusion. High-resolution CT of the thorax showed mediastinal lymphadenopathy and diffuse perilymphatic nodular opacities consistent with sarcoidosis. Sputum mycobacterial culture was negative. Fibreoptic bronchoscopy showed no endobronchial lesion but the transbronchial biopsy showed granulomatous inflammation with no evidence of infection, malignancy or foreign body. Pulmonary function tests were normal except for impairment of transfer factor. One year later, most of the cutaneous lesions had healed spontaneously. The CXR showed partial improvement of the right pleural opacification but little change in the lung field. The features of sarcoidosis and its association with silicone are reviewed.

A prospective epidemiologic survey on the prevalence of foot disease in Hong Kong.

A prospective epidemiologic survey on the prevalence of foot disease in Hong Kong found foot disease in 64% of patients screened. All of the patients were ethnically Chinese. Of the conditions specified in the questionnaire, fungal foot infection, tinea pedis, and toenail onychomycosis were the most frequently encountered conditions, followed by metatarsal corns, eczema, psoriasis, and pes planus. Vascular disease, osteoarticular pathology, diabetes mellitus, obesity, atopy, and participation in sports were the main factors coexisting with the foot conditions. Of the study population, 17% and 21% reported that their quality of life was affected by pain and discomfort, respectively. These percentages are much lower than those obtained in other studies; it may therefore be inferred that foot complaints are being neglected by the ethnic Chinese population in Hong Kong.

Perianal ulceration in a "healthy" Chinese man with disseminated tuberculosis.

Orificial tuberculosis (OTB) is a rare form of cutaneous Mycobacterium tuberculosis infection affecting the mucosa and skin around orifices in patients with advanced internal tuberculosis and poor general health. We report a 72-year-old Chinese man who had a 10-year history of OTB with disseminated tuberculosis infection of the lungs and urinary tract. He appeared surprisingly healthy and had been free from systemic symptoms all along despite widespread tuberculosis. The diagnosis of OTB was established by the microscopic presence of acid-fast bacilli (AFB) in the tissue section and was rapidly confirmed by polymerase chain reaction (PCR) to be Mycobacterium tuberculosis. PCR shortens the time of diagnosing rare presentations of cutaneous tuberculosis and prevents delays in treatment. Conventional culture is still important in confirming the diagnosis and screening for drug resistance.